Provider Demographics
NPI:1225065055
Name:BRADLEY, JOSHUA (ATC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 HIGHWAY 180 W
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-4400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:528 HIGHWAY 180 W
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4400
Practice Address - Country:US
Practice Address - Phone:575-534-1747
Practice Address - Fax:575-534-1748
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
050502025OtherNATABOC